Curvularia alcornii Infection
A 53-year-old man presented to the emergency department with sudden onset of paralysis in the lower legs. He reported a 2-month history of intermittent fevers. He worked as a gardener and had undergone bioprosthetic aortic-valve replacement 6 months before presentation. The results of physical examination were notable for fever, paralysis and numbness in both legs, and nonpalpable femoral pulses. No cutaneous lesions were identified. Computed tomographic angiography revealed a 9-cm ascending aortic pseudoaneurysm (Panel A, arrow) as well as multiple emboli in the superior mesenteric artery, the renal arteries, the infrarenal aorta, and the iliofemoral arteries. Transthoracic echocardiography showed a well-seated and normally functioning bioprosthetic aortic valve. Urgent embolectomy was performed. Microscopic examination of a dry smear stained with lactophenol cotton blue revealed hyphae with sympodial conidia (Panel B), and histopathological analysis showed narrow septate hyphae (Panel C, silver stain). The dematiaceous mold Curvularia alcornii, a fungus typically found in the soil, was grown in culture. The patient received treatment with liposomal amphotericin B and voriconazole. Surgical replacement of the aortic root and the ascending aorta was performed 2 weeks after presentation, and the patient was discharged with a prescription for long-term voriconazole therapy. Three months later, the patient again presented with fevers as well as new pseudoaneurysms in both iliac arteries. He died 2 months later from complications of this disseminated fungal infection.